Index

Artificial Feeding: its Technique and Problem

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Whole cow's milk is not recommended for infants. When breast-feeding is not feasible, artificial feeding needs to be practiced. Artificially fed infants should receive sterile water for the first feeding. Commercial formulas are modified from a cow's milk base, and their protein and ash levels are reduced nearer to those of human milk. The saturated fat of cow's milk is replaced with some unsaturated vegetable fatty acids, and vitamins are added. LBW (low birth weight) babies may benefit from the increased cystine of whey protein.

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Technique:

The setting should be similar to that for breast-feeding both in a comfortable position, unhurried, and free from distractions. The infant should be hungry, fully awake, warm, and dry and be held as though being breast-fed. The bottle should be held so that milk, not air, channels through the nipple. The bottle of milk is customarily warmed to body temperature. The temperature may be tested by dropping milk onto the wrist. The nipple holes should be of the size so that milk will drop slowly. The bottle should contain more than the average amount taken per feeding but left over after each feed should be discarded. Especially during the first 6-7 months of life, the eructation of air swallowed during feeding is important.

Preparation:

Hygienic practices are vital. Sterilization by boiling for 5-10 minutes of feeding bottles, teats are essential. The hands should be scrubbed thoroughly. The feeding bottles should be marked in ounces or milliliters. A wide-mouthed bottle is preferable because cleaning is easier, and those with an adequate cover for the nipple are preferable. One level spoonful of milk powder should be dissolved in one ounce/30ml of water. The preparation should not be concentrated or diluted.

Number of Feedings and quantity of feedings (a guide): Given as age : Nurnber/24hr : Amount/ feed

Underfeeding is suggested by restlessness and crying and by failure to thrive (FTT) despite complete emptying of the breast or bottle. It may result from the infant's failure to take a sufficient quantity of food even when offered. In these cases, the frequency of feedings, the mechanics of feeding, the size of the holes in the nipple, the adequacy of eructation of air, the possibility of abnormal mother-infant "bonding," and possible systemic disease in the baby should be investigated. The infant assumes the appearance of an old man. Deficiencies of vitamin A, B, C. and D and iron and protein may be responsible for characteristic clinical manifestations.
Treatment consists of increasing the fluid, calorie, vitamin and mineral intake, underlying systemic disease or psychological problem.

Overfeeding:

Overfeeding may be quantitative or qualitative. Regurgitation and vomiting are frequent symptoms. Diets too high in fat delay gastric emptying cause distention and abdominal discomfort, excessive gain in weight. Diets too high in carbohydrate to cause undue fermentation in the intestine resulting in distention and flatulence. Such diets may be deficient in essential protein, vitamins, and minerals. Obesity is undesirable at any time in life.

Posseting:

The return of small amounts of swallowed food during or shortly after eating is called "posseting" or "spitting up" More complete emptying the stomach, especially occurring some time after feeding, is called "vomiting. Within limits, regurgitation is a natural occurrence, especially during the first 6 months or so of life. It can be reduced by adequate eructation of swallowed air during and after eating, by gentle handling, by avoiding emotional conflicts, and by placing infant on the right side for a nap immediately after eating. Vomiting, one of the most common symptoms in infancy may be both trivial and serious. Its cause should always be investigated.

Diarrhoeal stools:

The stool of the breast-fed infant is naturally softer than that of the infant fed formula. Actual diarrhea in a breast-fed infant is unusual and should be considered infectious until proved otherwise. A breast-fed infant may pass stools as frequently as they breast-fed or 2-3 times a week. Although the stools of artificially fed infants tend to firmer than those of breast-fed infants, loose stools may result when formulas too concentrated or too high in sugar content, especially in lactose may produce loose, frequent stools. Mild diarrhoeal overfeeding respond quickly to temporary decrease or cessation of feeding.

Constipation:

Constipation is practically unknown in breast-fed infants. An infant will occasionally have a stool of normal consistency only at intervals of 36-48 hr. Constipation in the artificially fed infant may be caused by insufficient amount of food or fluid. It may result from diets too high in fat or protein or deficient in bulk. Increasing the amount of fluid or sugar in the formula may be corrective. It is better add foods with some bulk. Suppositories or luctulose should never be more than temporary measures. Anal fissures or cracks, aganglionic megacolon may be manifested by constipation.